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A toolbox for a structured risk-based prehabilitation program in major surgical oncology

Prehabilitation is a multimodal concept to improve functional capability prior to surgery, so that the patients’ resilience is strengthened to withstand any peri- and postoperative comorbidity. It covers physical activities, nutrition, and psychosocial wellbeing. The literature is heterogeneous in o...

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Autores principales: Sliwinski, Svenja, Werneburg, Elisabeth, Faqar-Uz-Zaman, Sara Fatima, Detemble, Charlotte, Dreilich, Julia, Mohr, Lisa, Zmuc, Dora, Beyer, Katharina, Bechstein, Wolf O., Herrle, Florian, Malkomes, Patrizia, Reissfelder, Christoph, Ritz, Joerg P., Vilz, Tim, Fleckenstein, Johannes, Schnitzbauer, Andreas A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10332323/
https://www.ncbi.nlm.nih.gov/pubmed/37435472
http://dx.doi.org/10.3389/fsurg.2023.1186971
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author Sliwinski, Svenja
Werneburg, Elisabeth
Faqar-Uz-Zaman, Sara Fatima
Detemble, Charlotte
Dreilich, Julia
Mohr, Lisa
Zmuc, Dora
Beyer, Katharina
Bechstein, Wolf O.
Herrle, Florian
Malkomes, Patrizia
Reissfelder, Christoph
Ritz, Joerg P.
Vilz, Tim
Fleckenstein, Johannes
Schnitzbauer, Andreas A.
author_facet Sliwinski, Svenja
Werneburg, Elisabeth
Faqar-Uz-Zaman, Sara Fatima
Detemble, Charlotte
Dreilich, Julia
Mohr, Lisa
Zmuc, Dora
Beyer, Katharina
Bechstein, Wolf O.
Herrle, Florian
Malkomes, Patrizia
Reissfelder, Christoph
Ritz, Joerg P.
Vilz, Tim
Fleckenstein, Johannes
Schnitzbauer, Andreas A.
author_sort Sliwinski, Svenja
collection PubMed
description Prehabilitation is a multimodal concept to improve functional capability prior to surgery, so that the patients’ resilience is strengthened to withstand any peri- and postoperative comorbidity. It covers physical activities, nutrition, and psychosocial wellbeing. The literature is heterogeneous in outcomes and definitions. In this scoping review, class 1 and 2 evidence was included to identify seven main aspects of prehabilitation for the treatment pathway: (i) risk assessment, (ii) FITT (frequency, interventions, time, type of exercise) principles of prehabilitation exercise, (iii) outcome measures, (iv) nutrition, (v) patient blood management, (vi) mental wellbeing, and (vii) economic potential. Recommendations include the risk of tumor progression due to delay of surgery. Patients undergoing prehabilitation should perceive risk assessment by structured, quantifiable, and validated tools like Risk Analysis Index, Charlson Comorbidity Index (CCI), American Society of Anesthesiology Score, or Eastern Co-operative Oncology Group scoring. Assessments should be repeated to quantify its effects. The most common types of exercise include breathing exercises and moderate- to high-intensity interval protocols. The program should have a duration of 3–6 weeks with 3–4 exercises per week that take 30–60 min. The 6-Minute Walking Testing is a valid and resource-saving tool to assess changes in aerobic capacity. Long-term assessment should include standardized outcome measurements (overall survival, 90-day survival, Dindo–Clavien/CCI®) to monitor the potential of up to 50% less morbidity. Finally, individual cost-revenue assessment can help assess health economics, confirming the hypothetic saving of $8 for treatment for $1 spent for prehabilitation. These recommendations should serve as a toolbox to generate hypotheses, discussion, and systematic approaches to develop clinical prehabilitation standards.
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spelling pubmed-103323232023-07-11 A toolbox for a structured risk-based prehabilitation program in major surgical oncology Sliwinski, Svenja Werneburg, Elisabeth Faqar-Uz-Zaman, Sara Fatima Detemble, Charlotte Dreilich, Julia Mohr, Lisa Zmuc, Dora Beyer, Katharina Bechstein, Wolf O. Herrle, Florian Malkomes, Patrizia Reissfelder, Christoph Ritz, Joerg P. Vilz, Tim Fleckenstein, Johannes Schnitzbauer, Andreas A. Front Surg Surgery Prehabilitation is a multimodal concept to improve functional capability prior to surgery, so that the patients’ resilience is strengthened to withstand any peri- and postoperative comorbidity. It covers physical activities, nutrition, and psychosocial wellbeing. The literature is heterogeneous in outcomes and definitions. In this scoping review, class 1 and 2 evidence was included to identify seven main aspects of prehabilitation for the treatment pathway: (i) risk assessment, (ii) FITT (frequency, interventions, time, type of exercise) principles of prehabilitation exercise, (iii) outcome measures, (iv) nutrition, (v) patient blood management, (vi) mental wellbeing, and (vii) economic potential. Recommendations include the risk of tumor progression due to delay of surgery. Patients undergoing prehabilitation should perceive risk assessment by structured, quantifiable, and validated tools like Risk Analysis Index, Charlson Comorbidity Index (CCI), American Society of Anesthesiology Score, or Eastern Co-operative Oncology Group scoring. Assessments should be repeated to quantify its effects. The most common types of exercise include breathing exercises and moderate- to high-intensity interval protocols. The program should have a duration of 3–6 weeks with 3–4 exercises per week that take 30–60 min. The 6-Minute Walking Testing is a valid and resource-saving tool to assess changes in aerobic capacity. Long-term assessment should include standardized outcome measurements (overall survival, 90-day survival, Dindo–Clavien/CCI®) to monitor the potential of up to 50% less morbidity. Finally, individual cost-revenue assessment can help assess health economics, confirming the hypothetic saving of $8 for treatment for $1 spent for prehabilitation. These recommendations should serve as a toolbox to generate hypotheses, discussion, and systematic approaches to develop clinical prehabilitation standards. Frontiers Media S.A. 2023-06-26 /pmc/articles/PMC10332323/ /pubmed/37435472 http://dx.doi.org/10.3389/fsurg.2023.1186971 Text en © 2023 Sliwinski, Werneburg, Faqar-Uz-Zaman, Detemble, Dreilich, Mohr, Zmuc, Beyer, Bechstein, Herrle, Malkomes, Reissfelder, Ritz, Vilz, Fleckenstein and Schnitzbauer. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Surgery
Sliwinski, Svenja
Werneburg, Elisabeth
Faqar-Uz-Zaman, Sara Fatima
Detemble, Charlotte
Dreilich, Julia
Mohr, Lisa
Zmuc, Dora
Beyer, Katharina
Bechstein, Wolf O.
Herrle, Florian
Malkomes, Patrizia
Reissfelder, Christoph
Ritz, Joerg P.
Vilz, Tim
Fleckenstein, Johannes
Schnitzbauer, Andreas A.
A toolbox for a structured risk-based prehabilitation program in major surgical oncology
title A toolbox for a structured risk-based prehabilitation program in major surgical oncology
title_full A toolbox for a structured risk-based prehabilitation program in major surgical oncology
title_fullStr A toolbox for a structured risk-based prehabilitation program in major surgical oncology
title_full_unstemmed A toolbox for a structured risk-based prehabilitation program in major surgical oncology
title_short A toolbox for a structured risk-based prehabilitation program in major surgical oncology
title_sort toolbox for a structured risk-based prehabilitation program in major surgical oncology
topic Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10332323/
https://www.ncbi.nlm.nih.gov/pubmed/37435472
http://dx.doi.org/10.3389/fsurg.2023.1186971
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